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Russell TB, Labib PL, Murphy P, Ausania F, Pando E, Roberts KJ, Kausar A, Mavroeidis VK, Marangoni G, Thomasset SC, Frampton AE, Lykoudis P, Maglione M, Alhaboob N, Bari H, Smith AM, Spalding D, Srinivasan P, Davidson BR, Bhogal RH, Croagh D, Dominguez I, Thakkar R, Gomez D, Silva MA, Lapolla P, Mingoli A, Porcu A, Shah NS, Hamady ZZR, Al-Sarrieh B, Serrablo A, Aroori S. Do some patients receive unnecessary parenteral nutrition after pancreatoduodenectomy? Results from an international multicentre study. Ann Hepatobiliary Pancreat Surg 2024; 28:70-79. [PMID: 38092429 PMCID: PMC10896679 DOI: 10.14701/ahbps.23-071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/19/2023] [Accepted: 07/26/2023] [Indexed: 02/21/2024] Open
Abstract
Backgrounds/Aims After pancreatoduodenectomy (PD), an early oral diet is recommended; however, the postoperative nutritional management of PD patients is known to be highly variable, with some centers still routinely providing parenteral nutrition (PN). Some patients who receive PN experience clinically significant complications, underscoring its judicious use. Using a large cohort, this study aimed to determine the proportion of PD patients who received postoperative nutritional support (NS), describe the nature of this support, and investigate whether receiving PN correlated with adverse perioperative outcomes. Methods Data were extracted from the Recurrence After Whipple's study, a retrospective multicenter study of PD outcomes. Results In total, 1,323 patients (89%) had data on their postoperative NS status available. Of these, 45% received postoperative NS, which was "enteral only," "parenteral only," and "enteral and parenteral" in 44%, 35%, and 21% of cases, respectively. Body mass index < 18.5 kg/m2 (p = 0.03), absence of preoperative biliary stenting (p = 0.009), and serum albumin < 36 g/L (p = 0.009) all correlated with receiving postoperative NS. Among those who did not develop a serious postoperative complication, i.e., those who had a relatively uneventful recovery, 20% received PN. Conclusions A considerable number of patients who had an uneventful recovery received PN. PN is not without risk, and should be reserved for those who are unable to take an oral diet. PD patients should undergo pre- and postoperative assessment by nutrition professionals to ensure they are managed appropriately, and to optimize perioperative outcomes.
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Affiliation(s)
- Thomas B. Russell
- Department of HPB Surgery, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Peter L. Labib
- Department of HPB Surgery, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Paula Murphy
- Department of HPB Surgery, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Fabio Ausania
- Department of HPB Surgery, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Elizabeth Pando
- Department of HPB Surgery, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Keith J. Roberts
- Department of HPB Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ambareen Kausar
- Department of HPB Surgery, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Vasileios K. Mavroeidis
- Department of HPB Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Department of HPB Surgery, The Royal Marsden NHS Foundation Trust, London, UK
| | - Gabriele Marangoni
- Department of HPB Surgery, University Hospital Coventry & Warwickshire, Coventry, UK
| | | | - Adam E. Frampton
- Department of HPB Surgery, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Pavlos Lykoudis
- Department of HPB Surgery, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Manuel Maglione
- Department of HPB Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Nassir Alhaboob
- Department of HPB Surgery, Ibn Sina Specialized Hospital, Khartoum, Sudan
| | - Hassaan Bari
- Department of HPB Surgery, Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan
| | - Andrew M. Smith
- Department of HPB Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Duncan Spalding
- Department of HPB Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Parthi Srinivasan
- Department of HPB Surgery, King’s College Hospital NHS Foundation Trust, London, UK
| | - Brian R. Davidson
- Department of HPB Surgery, Royal Free London NHS Foundation Trust, London, UK
| | - Ricky H. Bhogal
- Department of HPB Surgery, The Royal Marsden NHS Foundation Trust, London, UK
| | - Daniel Croagh
- Department of HPB Surgery, Monash Medical Centre, Melbourne, Australia
| | - Ismael Dominguez
- Department of HPB Surgery, Salvador Zubiran National Institute of Health Sciences and Nutrition, Mexico City, Mexico
| | - Rohan Thakkar
- Department of HPB Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Dhanny Gomez
- Department of HPB Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Michael A. Silva
- Department of HPB Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Pierfrancesco Lapolla
- Department of HPB Surgery, Policlinico Umberto I University Hospital Sapienza, Rome, Italy
| | - Andrea Mingoli
- Department of HPB Surgery, Policlinico Umberto I University Hospital Sapienza, Rome, Italy
| | - Alberto Porcu
- Department of HPB Surgery, Azienda Ospedaliero Universitaria di Sassari, Sassari, Italy
| | - Nehal S. Shah
- Department of HPB Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Zaed Z. R. Hamady
- Department of HPB Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Bilal Al-Sarrieh
- Department of HPB Surgery, Swansea Bay University Health Board, Swansea, UK
| | - Alejandro Serrablo
- Department of HPB Surgery, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Somaiah Aroori
- Department of HPB Surgery, University Hospitals Plymouth NHS Trust, Plymouth, UK
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Wawrzyniak P, Hubeli B, Wawrzyniak M, Noureddine N, Walberg A, Scharl S, Turina M, Scharl M, Zaugg M, Krämer SD, Rogler G, Hersberger M. Crosstalk within peripheral blood mononuclear cells mediates anti-inflammatory effects of n-3 PUFA-rich lipid emulsions in parenteral nutrition. Clin Nutr 2023; 42:2422-2433. [PMID: 37871483 DOI: 10.1016/j.clnu.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND AND AIMS Parenteral nutrition (PN) rich in n-6 and n-3 long-chain fatty acids is used in clinical practice for nourishing patients who are unable to receive adequate nutrition through their digestive systems. In this study, we compare the effect on inflammation of the commonly used lipid emulsions Omegaven (n-3-rich) and Intralipid (n-6-rich) in human peripheral blood mononuclear cells (PBMCs). METHODS PBMCs were treated with different doses of n-3-rich Omegaven and n-6-rich Intralipid and the immune cells were characterized by flow cytometry. RESULTS We show that incubation of PBMCs with n-3-rich Omegaven leads to an increase in expression of CD1d and CD86 in CD14+monocytes. At the same time, an increased number of NKT cells expressing cytotoxic T cell antigen 4 is observed, suggesting immunological synapse formation. Both CD14+monocytes and NKT cells showed an increase in IL-10 production and a reduction in the pro-inflammatory cytokines IFN-γ, TNF-α, and IL-4, which led to an increase in the number of FOXP3+T regulatory cells. In addition, we show that n-3-rich Omegaven reduces the expression of TNFα, IFNγ and IL-4 in CD4+T and CD8+T cells independent of the presented interaction between CD14+monocytes and NKT cells. The described mechanism of n-3 rich lipid emulsions was confirmed in PBMCs from patients with inflammatory bowel disease but not in colorectal cancer patients which seem to lack the interaction between CD14+monocytes and NKT cells. CONCLUSIONS These results show a mechanism for the beneficial effect of the n-3-rich Omegaven in patients with inflammatory conditions but questions its use in patients with cancer. Hence, our results may assist in choosing the best lipid emulsion for patients who require PN.
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Affiliation(s)
- Paulina Wawrzyniak
- Division of Clinical Chemistry and Biochemistry and Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Barbara Hubeli
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marcin Wawrzyniak
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nazek Noureddine
- Division of Clinical Chemistry and Biochemistry and Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Asa Walberg
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sylvie Scharl
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matthias Turina
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Michael Scharl
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael Zaugg
- Department of Anesthesiology and Pain Medicine and Cardiovascular Research Centre, University of Alberta, Canada; Department of Pharmacology, University of Alberta, Canada
| | - Stefanie D Krämer
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
| | - Gerhard Rogler
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martin Hersberger
- Division of Clinical Chemistry and Biochemistry and Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Schweckendiek D, Pauli D, Scharl M. [Eating disorders - what the gastroenterologist needs to know]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:1484-1493. [PMID: 37156504 DOI: 10.1055/a-2010-3883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Eating disorders are potentially life-threatening disorders that go along with severe psychiatric and somatic comorbidities. It is expected that the number of patients will dramatically increase in the post COVID-19 pandemic era.Four main eating disorders are mentioned in the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) and the International Classification of Diseases 11 (ICD-11): anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED) und avoidant restrictive food intake disorder (ARFID). Many traditional assumptions in eating disorders are currently challenged due to recent research results. The gastroenterologist is usually not the first point of contact for patients with eating disorders. However, he is crucial, especially in the management of gastroenterologic complications of eating disorders.Focus of the overview will be on relevant gastroenterologic aspects and less on the psychiatric treatment. Basics of the most common eating disorders will be repeated, opportunities in diagnosing an eating disorder and the most relevant gastroenterologic complications will be described. Obesity and its management, an entity that often goes along with an eating disorder, is not in the spotlight of the review.
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Affiliation(s)
| | - Dagmar Pauli
- Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Psychiatrische Universitatsklinik Zürich, Zürich, Schweiz
| | - Michael Scharl
- Klinik für Gastroenterologie und Hepatologie, Universitätsspital Zürich, Zürich, Schweiz
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Ishibashi S, Kumori K, Manako J, Funabashi N, Senaha Y, Hidaka M. Open Gastrostomy by Mini-Laparotomy: Our Method. Cureus 2023; 15:e45506. [PMID: 37868450 PMCID: PMC10585052 DOI: 10.7759/cureus.45506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
When percutaneous endoscopic gastrostomy (PEG) is not feasible owing to anatomical obstacles, laparotomic or laparoscopic gastrostomy (LAG) is an alternative. At our institution, LAG has been the first choice for patients who are unable to undergo PEG; however, we have introduced a small open gastrostomy through a 2-cm-long transverse incision since 2020. By December 2022, 12 patients had undergone this procedure without complications. In one case where the stomach was located cephalad to the rib arch and the patient had a round dorsum, the incision wound was extended, and a lengthy operation was required. We believe that our small-incision gastrostomy is a useful option in addition to LAG for cases in which PEG is difficult to perform. Further studies are required to determine the indications for this procedure.
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Affiliation(s)
- Shuichi Ishibashi
- Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, JPN
| | - Koji Kumori
- Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, JPN
| | - Junko Manako
- Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, JPN
| | - Narimasa Funabashi
- Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, JPN
| | - Yoko Senaha
- Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, JPN
| | - Masaaki Hidaka
- Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, JPN
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5
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Cheon S, Oh SH, Kim JT, Choi HG, Park H, Chung JE. Nutrition Therapy by Nutrition Support Team: A Comparison of Multi-Chamber Bag and Customized Parenteral Nutrition in Hospitalized Patients. Nutrients 2023; 15:nu15112531. [PMID: 37299494 DOI: 10.3390/nu15112531] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/26/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
This study aimed to investigate the activity of a nutrition support team (NST) and the trends of multi-chamber bag (MCB) and customized parenteral nutrition (PN) with NST consultations in South Korea. Data were obtained from the National Inpatient Sample Cohort between 2015 and 2020. Three datasets were constructed for NST consultation, MCB-PN product prescriptions, and aseptic preparation of total PN. The intersections of the NST consultation and each PN dataset were compiled into MCB-PN with NST or customized PN with a NST sub-dataset, respectively. Using personal identifiers, the patients' characteristics were evaluated in the NST cohort. A total of 91,384 reimbursements and 70,665 patients were included. The NST activity had increased by more than 50% over 6 years. Approximately 70% and 11%, respectively, of the NST cohort were classified into two subgroups: MCB-PN with NST (M-NST) and customized PN with NST (C-NST). M-NST had many elderly patients with cancer and showed a higher in-hospital mortality than C-NST (12.6% vs. 9.5%). C-NST included a larger number of patients under the age of 5 years, and the hospitalization period was more extended than M-NST (26.2 vs. 21.2 days). The present study showed that NST activities and the proportion of PN with NST consultation are gradually increasing in South Korea.
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Affiliation(s)
- Seunghyun Cheon
- College of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University, Ansan-si 15588, Gyeonggi-do, Republic of Korea
| | - Sang-Hyeon Oh
- College of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University, Ansan-si 15588, Gyeonggi-do, Republic of Korea
| | - Jung-Tae Kim
- Department of Pharmacy, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea
| | - Han-Gon Choi
- College of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University, Ansan-si 15588, Gyeonggi-do, Republic of Korea
| | - Hyojung Park
- Department of Pharmaceutical Services, Samsung Medical Center, Seoul 06351, Republic of Korea
- School of Pharmacy, Sungkyunkwan University, Suwon-si 16419, Gyeonggi-do, Republic of Korea
| | - Jee-Eun Chung
- College of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University, Ansan-si 15588, Gyeonggi-do, Republic of Korea
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6
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dos Santos CL, dos Santos LL, Tavares G, Tristão LS, Orlandini MF, Serafim MCA, Datrino LN, Bernardo WM, Tustumi F. Prophylactic thoracic duct obliteration and resection during esophagectomy: What is the impact on perioperative risks and long‐term survival? A systematic review and meta‐analysis. J Surg Oncol 2022; 126:90-98. [DOI: 10.1002/jso.26827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/06/2022] [Accepted: 02/08/2022] [Indexed: 01/27/2023]
Affiliation(s)
- Clara L. dos Santos
- Department of Evidence‐based Medicine Centro Universitário Lusíada Santos SP Brazil
| | - Laura L. dos Santos
- Department of Gastroenterology Universidade de São Paulo Sao Paulo SP Brazil
| | - Guilherme Tavares
- Department of Evidence‐based Medicine Centro Universitário Lusíada Santos SP Brazil
| | - Luca S. Tristão
- Department of Evidence‐based Medicine Centro Universitário Lusíada Santos SP Brazil
| | - Marina F. Orlandini
- Department of Evidence‐based Medicine Centro Universitário Lusíada Santos SP Brazil
| | - Maria C. A. Serafim
- Department of Evidence‐based Medicine Centro Universitário Lusíada Santos SP Brazil
| | - Letícia N. Datrino
- Department of Evidence‐based Medicine Centro Universitário Lusíada Santos SP Brazil
| | - Wanderley M. Bernardo
- Department of Evidence‐based Medicine Centro Universitário Lusíada Santos SP Brazil
- Department of Gastroenterology Universidade de São Paulo Sao Paulo SP Brazil
| | - Francisco Tustumi
- Department of Evidence‐based Medicine Centro Universitário Lusíada Santos SP Brazil
- Department of Gastroenterology Universidade de São Paulo Sao Paulo SP Brazil
- Department of Surgery Hospital Israelita Albert Einstein Sao Paulo SP Brazil
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7
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Laher AE, McDowall J, van Welie M, Malinga DM, Craythorne AJ, van Aardt BJ, Dalvie T, Richards GA. Nutritional support practices at an intensive care unit in Johannesburg, South Africa. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2022. [DOI: 10.1080/16070658.2022.2052412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Abdullah E Laher
- Department of Emergency Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Jared McDowall
- Department of Emergency Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Mikayla van Welie
- Department of Emergency Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Domenic M Malinga
- Department of Emergency Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Alistair J Craythorne
- Department of Emergency Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Brandon J van Aardt
- Department of Emergency Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Tasneem Dalvie
- Department of Critical Care, University of the Witwatersrand, Johannesburg, South Africa
| | - Guy A Richards
- Department of Critical Care, University of the Witwatersrand, Johannesburg, South Africa
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8
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Karayiannis D, Kakavas S, Sarri A, Giannopoulou V, Liakopoulou C, Jahaj E, Kanavou A, Pitsolis T, Malachias S, Adamos G, Mantelou A, Almperti A, Morogianni K, Kampouropoulou O, Kotanidou A, Mastora Z. Does Route of Full Feeding Affect Outcome among Ventilated Critically Ill COVID-19 Patients: A Prospective Observational Study. Nutrients 2021; 14:nu14010153. [PMID: 35011026 PMCID: PMC8746666 DOI: 10.3390/nu14010153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/25/2021] [Accepted: 12/26/2021] [Indexed: 01/17/2023] Open
Abstract
The outbreak of the new coronavirus strain SARS-CoV-2 (COVID-19) highlighted the need for appropriate feeding practices among critically ill patients admitted to the intensive care unit (ICU). This study aimed to describe feeding practices of intubated COVID-19 patients during their second week of hospitalization in the First Department of Critical Care Medicine, Evaggelismos General Hospital, and evaluate potential associations with all cause 30-day mortality, length of hospital stay, and duration of mechanical ventilation. We enrolled adult intubated COVID-19 patients admitted to the ICU between September 2020 and July 2021 and prospectively monitored until their hospital discharge. Of the 162 patients analyzed (52.8% men, 51.6% overweight/obese, mean age 63.2 ± 11.9 years), 27.2% of patients used parenteral nutrition, while the rest were fed enterally. By 30 days, 34.2% of the patients in the parenteral group had died compared to 32.7% of the patients in the enteral group (relative risk (RR) for the group receiving enteral nutrition = 0.97, 95% confidence interval = 0.88–1.06, p = 0.120). Those in the enteral group demonstrated a lower duration of hospital stay (RR = 0.91, 95% CI = 0.85-0.97, p = 0.036) as well as mechanical ventilation support (RR = 0.94, 95% CI = 0.89–0.99, p = 0.043). Enteral feeding during second week of ICU hospitalization may be associated with a shorter duration of hospitalization and stay in mechanical ventilation support among critically ill intubated patients with COVID-19.
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Affiliation(s)
- Dimitrios Karayiannis
- Department of Clinical Nutrition, “Evangelismos” General Hospital of Athens, Ypsilantou 45-47, 10676 Athens, Greece; (A.A.); (K.M.)
- Correspondence: ; Tel.: +30-213-2045035; Fax: +30-213-2041385
| | - Sotirios Kakavas
- Intensive Care Unit, Center for Respiratory Failure, “Sotiria” General Hospital of Chest Diseases, 152 Mesogeion Avenue, 11527 Athens, Greece;
| | - Aikaterini Sarri
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.S.); (V.G.); (C.L.); (E.J.); (A.K.); (T.P.); (S.M.); (G.A.); (A.M.); (O.K.); (A.K.); (Z.M.)
| | - Vassiliki Giannopoulou
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.S.); (V.G.); (C.L.); (E.J.); (A.K.); (T.P.); (S.M.); (G.A.); (A.M.); (O.K.); (A.K.); (Z.M.)
| | - Christina Liakopoulou
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.S.); (V.G.); (C.L.); (E.J.); (A.K.); (T.P.); (S.M.); (G.A.); (A.M.); (O.K.); (A.K.); (Z.M.)
| | - Edison Jahaj
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.S.); (V.G.); (C.L.); (E.J.); (A.K.); (T.P.); (S.M.); (G.A.); (A.M.); (O.K.); (A.K.); (Z.M.)
| | - Aggeliki Kanavou
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.S.); (V.G.); (C.L.); (E.J.); (A.K.); (T.P.); (S.M.); (G.A.); (A.M.); (O.K.); (A.K.); (Z.M.)
| | - Thodoris Pitsolis
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.S.); (V.G.); (C.L.); (E.J.); (A.K.); (T.P.); (S.M.); (G.A.); (A.M.); (O.K.); (A.K.); (Z.M.)
| | - Sotirios Malachias
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.S.); (V.G.); (C.L.); (E.J.); (A.K.); (T.P.); (S.M.); (G.A.); (A.M.); (O.K.); (A.K.); (Z.M.)
| | - George Adamos
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.S.); (V.G.); (C.L.); (E.J.); (A.K.); (T.P.); (S.M.); (G.A.); (A.M.); (O.K.); (A.K.); (Z.M.)
| | - Athina Mantelou
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.S.); (V.G.); (C.L.); (E.J.); (A.K.); (T.P.); (S.M.); (G.A.); (A.M.); (O.K.); (A.K.); (Z.M.)
| | - Avra Almperti
- Department of Clinical Nutrition, “Evangelismos” General Hospital of Athens, Ypsilantou 45-47, 10676 Athens, Greece; (A.A.); (K.M.)
| | - Konstantina Morogianni
- Department of Clinical Nutrition, “Evangelismos” General Hospital of Athens, Ypsilantou 45-47, 10676 Athens, Greece; (A.A.); (K.M.)
| | - Olga Kampouropoulou
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.S.); (V.G.); (C.L.); (E.J.); (A.K.); (T.P.); (S.M.); (G.A.); (A.M.); (O.K.); (A.K.); (Z.M.)
| | - Anastasia Kotanidou
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.S.); (V.G.); (C.L.); (E.J.); (A.K.); (T.P.); (S.M.); (G.A.); (A.M.); (O.K.); (A.K.); (Z.M.)
| | - Zafeiria Mastora
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.S.); (V.G.); (C.L.); (E.J.); (A.K.); (T.P.); (S.M.); (G.A.); (A.M.); (O.K.); (A.K.); (Z.M.)
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9
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Ong XYS, Sultana R, Tan JWS, Tan QX, Wong JSM, Chia CS, Ong CAJ. The Role of Total Parenteral Nutrition in Patients with Peritoneal Carcinomatosis: A Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:4156. [PMID: 34439309 PMCID: PMC8393754 DOI: 10.3390/cancers13164156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 01/23/2023] Open
Abstract
Peritoneal carcinomatosis (PC) is often associated with malnutrition and an inability to tolerate enteral feeding. Although total parenteral nutrition (TPN) can be lifesaving for patients with no other means of nutritional support, its use in the management of PC patients remains controversial. Therefore, a systematic review and meta-analysis was performed to evaluate the benefit of TPN on the overall survival of PC patients, in accordance with PRISMA guidelines. A total of 187 articles were screened; 10 were included in this review and eight were included in the meta-analysis. The pooled median overall survival of patients who received TPN was significantly higher than patients who did not receive TPN (p = 0.040). When only high-quality studies were included, a significant survival advantage was observed in PC patients receiving TPN (p < 0.001). Subgroup analysis of patients receiving chemotherapy demonstrated a significant survival benefit (p = 0.008) associated with the use of TPN. In conclusion, TPN may improve survival outcomes in PC patients. However, further studies are needed to conclude more definitively on the effect of TPN.
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Affiliation(s)
- Xing-Yi Sarah Ong
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore; (X.-Y.S.O.); (J.W.-S.T.); (Q.X.T.); (J.S.M.W.); (C.S.C.)
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore 169608, Singapore
- Duke-NUS Medical School, Singapore 169857, Singapore;
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore 169610, Singapore
| | | | - Joey Wee-Shan Tan
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore; (X.-Y.S.O.); (J.W.-S.T.); (Q.X.T.); (J.S.M.W.); (C.S.C.)
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore 169608, Singapore
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore 169610, Singapore
| | - Qiu Xuan Tan
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore; (X.-Y.S.O.); (J.W.-S.T.); (Q.X.T.); (J.S.M.W.); (C.S.C.)
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore 169608, Singapore
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore 169610, Singapore
| | - Jolene Si Min Wong
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore; (X.-Y.S.O.); (J.W.-S.T.); (Q.X.T.); (J.S.M.W.); (C.S.C.)
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore 169608, Singapore
| | - Claramae Shulyn Chia
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore; (X.-Y.S.O.); (J.W.-S.T.); (Q.X.T.); (J.S.M.W.); (C.S.C.)
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore 169608, Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Chin-Ann Johnny Ong
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore; (X.-Y.S.O.); (J.W.-S.T.); (Q.X.T.); (J.S.M.W.); (C.S.C.)
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore 169608, Singapore
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore 169610, Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
- Institute of Molecular and Cell Biology, A*STAR Research Entities, Singapore 138673, Singapore
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Kwon JH, Yoon YI, Song GW, Kim KH, Moon DB, Jung DH, Park GC, Tak EY, Kirchner VA, Lee SG. Living Donor Liver Transplantation for Patients Older Than Age 70 Years: A Single-Center Experience. Am J Transplant 2017; 17:2890-2900. [PMID: 28510341 DOI: 10.1111/ajt.14355] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 05/01/2017] [Accepted: 05/04/2017] [Indexed: 01/25/2023]
Abstract
Over the past two decades, the age of liver transplantation (LT) recipients has been increasing. We reviewed our experience with LT for patients aged ≥70 years (range: 70-78 years) and investigated the feasibility of performing LT, especially living donor LT (LDLT), for older patients. We retrospectively reviewed the medical records of 25 patients (15 LDLT recipients, 10 deceased donor LT recipients) aged ≥70 years who underwent LT from January 2000 to April 2016. Their perioperative morbidity rate was 28.0%, and the in-hospital mortality rate was 16.0%; these results were comparable to those of matched patients in their 60s (n = 73; morbidity, p = 0.726; mortality, p = 0.816). For patients in their 70s, the 1- and 5-year patient survival rates were 84.0% and 69.8%, and the 1- and 5-year graft survival rates were 83.5% and 75.1%, respectively. Comparisons of patient and graft survival rates between matched patients in their 60s and 70s showed no statistically significant differences (patient survival, p = 0.372; graft survival, p = 0.183). Our experience suggests that patients aged ≥70 years should not be excluded from LT, or even LDLT, based solely on age and implies that careful selection of recipients and donors as well as meticulous surgical technique are necessary for successful results.
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Affiliation(s)
- J H Kwon
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Y I Yoon
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Korea University Medical Center, University of Korea College of Medicine, Seoul, Korea
| | - G W Song
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - K H Kim
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - D B Moon
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - D H Jung
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - G C Park
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - E Y Tak
- Asan Institute for Life Sciences and Asan-Minnesota Institute for Innovating Transplantation, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - V A Kirchner
- Division of Transplantation, Department of Surgery and Asan-Minnesota Institute for Innovating Transplantation, University of Minnesota, Minneapolis, MN
| | - S G Lee
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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11
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Ramos A, Zapata L, Vera P, Betbese AJ, Pérez A. Transition from intravenous insulin to subcutaneous long-acting insulin in critical care patients on enteral or parenteral nutrition. ACTA ACUST UNITED AC 2017; 64:552-556. [PMID: 29179857 DOI: 10.1016/j.endinu.2017.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 06/01/2017] [Accepted: 08/01/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS The optimal initial dose of subcutaneous (SC) insulin after intravenous (IV) infusion is controversial, especially in patients receiving continuous enteral nutrition (EN) or total parenteral nutrition (TPN). The aim of this study was to evaluate the strategy used at our hospital intensive care unit (ICU) in patients switched from IV insulin to SC insulin glargine while receiving EN or TPN. DESIGN AND METHODS A retrospective analysis was made of 27 patients on EN and 14 on TPN switched from IV infusion insulin to SC insulin. The initial dose of SC insulin was estimated as 50% of the daily IV insulin requirements, extrapolated from the previous 12h. A corrective dose of short-acting insulin (lispro) was used when necessary. RESULTS Mean blood glucose (BG) level during SC insulin treatment was 136±35mg/dL in the EN group and 157±37mg/dL in the TPN group (p=0.01). In the TPN group, mean BG was >180mg/dL during the first three days after switching, and a 41% increase in the glargine dose was required to achieve the target BG. In the EN group, mean BG remained <180mg/dL throughout the days of transition and the dose of glargine remained unchanged. CONCLUSIONS In the transition from IV to SC insulin therapy, initial insulin glargine dose estimated as 50% of daily IV insulin requirements is adequate for patients on EN, but inadequate in those given TPN.
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Affiliation(s)
- Analía Ramos
- Department of Endocrinology & Nutrition, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Lluis Zapata
- Department of Critical Care Medicine, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Paula Vera
- Department of Critical Care Medicine, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Antoni J Betbese
- Department of Critical Care Medicine, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Antonio Pérez
- Department of Endocrinology & Nutrition, Hospital Santa Creu i Sant Pau, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain.
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12
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Affiliation(s)
- Sarita Singhal
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY.,Digestive Diseases and Nutrition Center, Women and Children's Hospital of Buffalo, Kaleida Health, Buffalo, NY
| | - Susan S Baker
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY.,Digestive Diseases and Nutrition Center, Women and Children's Hospital of Buffalo, Kaleida Health, Buffalo, NY
| | - Georgina A Bojczuk
- Digestive Diseases and Nutrition Center, Women and Children's Hospital of Buffalo, Kaleida Health, Buffalo, NY
| | - Robert D Baker
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY.,Digestive Diseases and Nutrition Center, Women and Children's Hospital of Buffalo, Kaleida Health, Buffalo, NY
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13
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Efficacy and Complications of Enteral Feeding Tube Insertion After Liver Transplantation. Transplant Proc 2015; 47:451-6. [DOI: 10.1016/j.transproceed.2014.11.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 11/04/2014] [Accepted: 11/19/2014] [Indexed: 11/18/2022]
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14
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Factores asociados a complicaciones de yeyunostomía. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2013; 78:64-9. [DOI: 10.1016/j.rgmx.2013.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 12/10/2012] [Accepted: 01/21/2013] [Indexed: 11/23/2022]
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15
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Hoffer LJ, Bistrian BR. Why critically ill patients are protein deprived. JPEN J Parenter Enteral Nutr 2013; 37:300-9. [PMID: 23459750 DOI: 10.1177/0148607113478192] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Critical illness dramatically increases muscle proteolysis and more than doubles the dietary protein requirement. Yet surprisingly, most critically ill patients receive less than half the recommended amount of protein during their stay in a modern intensive care unit. What could explain the wide gap between the recommendations in clinical care guidelines and actual clinical practice? We suggest that an important aspect of the problem is the failure of guidelines to explain the pathophysiology of protein-energy malnutrition and the ways critical illness modifies protein metabolism. The difficulty created by the lack of a framework for reasoning about appropriate protein provision in critical illness is compounded by the many ambiguous and often contradictory ways the word malnutrition is used in the critical care literature. Failing to elucidate these matters, the recommendations for protein provision in the guidelines are incoherent, unconvincing, and easy to ignore.
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Affiliation(s)
- L John Hoffer
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
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16
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Huang HH, Chang SJ, Hsu CW, Chang TM, Kang SP, Liu MY. Severity of illness influences the efficacy of enteral feeding route on clinical outcomes in patients with critical illness. J Acad Nutr Diet 2012; 112:1138-46. [PMID: 22682883 DOI: 10.1016/j.jand.2012.04.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Accepted: 04/14/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Few trials have studied the influence of illness severity on clinical outcomes of different tube-feeding routes. Whether gastric or postpyloric feeding route is more beneficial to patients receiving enteral nutrition remains controversial. OBJECTIVE To test whether illness severity influences the efficacy of enteral feeding route on clinical outcomes in patients with critical illness. DESIGN A 2-year prospective, randomized, clinical study was conducted to assess the differences between the nasogastric (NG) and nasoduodenal (ND) tube feedings on clinical outcomes. PARTICIPANTS/SETTING One hundred one medical adult intensive care unit (ICU) patients requiring enteral nutrition were enrolled in this study. INTERVENTION Patients were randomly assigned to the NG (n=51) or ND (n=50) feeding route during a 21-day study period. Illness severity was dichotomized as "less severe" and "more severe," with the cutoff set at Acute Physiology and Chronic Health Evaluation II score of 20. MAIN OUTCOME MEASURES Daily energy and protein intake, feeding complications (eg, gastric retention/vomiting/diarrhea/gastrointestinal bleeding), length of ICU stay, hospital mortality, nitrogen balance, albumin, and prealbumin. STATISTICAL ANALYSES PERFORMED Two-tailed Student t tests and Mann-Whitney U tests were used to analyze significant differences between variables in the study groups. Multiple regression was used to assess the effects of illness severity and enteral feeding routes on clinical outcomes. RESULTS Among less severely ill patients, no differences existed between the NG and ND groups in daily energy and protein intake, feeding complications, length of ICU stay, and nitrogen balance. Among more severely ill patients, the NG group experienced lower energy and protein intake, more tube feeding complications, longer ICU stay, and poorer nitrogen balance than the ND group. CONCLUSIONS To optimize nutritional support and taking medical resources into account, the gastric feeding route is recommended for less severely ill patients and the postpyloric feeding route for more severely ill patients.
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Affiliation(s)
- Hsiu-Hua Huang
- Department of Life Sciences, College of Bioscience and Biotechnology, National Cheng Kung University, No. 1 University Rd., Tainan City 701, Taiwan
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Current considerations of direct percutaneous endoscopic jejunostomy. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2012; 26:92-6. [PMID: 22312608 DOI: 10.1155/2012/319843] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
UNLABELLED BACKGROUOND: Direct percutaneous endoscopic jejunostomy (DPEJ) is a well-known approach to deliver postpyloric enteral nutritional support to individuals who cannot tolerate gastric feeding. However, it is technically difficult, and some case series have reported significant procedural failure rates. The present article describes current indications, successes and complications of DPEJ placement. METHODS A MEDLINE database search was performed to identify relevant articles using the key words "direct percutaneous endoscopic jejunostomy", "percutaneous endoscopic gastrostomy", and "percutaneous endoscopic gastrostomy with a jejunal extension tube". Additional articles were identified by a manual search of the references cited in the key articles obtained in the primary search. RESULTS DPEJ is gradually becoming more common in the treatment of patients who cannot tolerate gastric feeding. Differences in patient selection and technique modifications may contribute to the various success rates reported. Failure is most often due to inadequate transillumination or gastroduodenal obstruction. Currently, there are limited data to evaluate the safety and effectiveness of DPEJ. CONCLUSION The clinical use of DPEJ is increasing. With appropriate care and expertise, DPEJ may prove to be reliable and safe.
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Cahill NE, Murch L, Jeejeebhoy K, McClave SA, Day AG, Wang M, Heyland DK. When early enteral feeding is not possible in critically ill patients: results of a multicenter observational study. JPEN J Parenter Enteral Nutr 2011; 35:160-8. [PMID: 21378245 DOI: 10.1177/0148607110381405] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Early enteral nutrition (EN) is the preferred strategy for feeding the critically ill; however, it is not always possible to initiate EN within the recommended 24 to 48 hours. When these situations arise, controversy exists whether to start feeding early via the parenteral route or to delay feeding until EN can be provided. METHODS A multicenter, international, observational study examined nutrition practices in intensive care units (ICUs). Eligible patients were critically ill patients with a medical diagnosis who remained in the ICU for >72 hours and received EN >48 hours after admission. Data were collected on site, including patient characteristics, daily nutrition practices, and outcomes at 60 days. Nutrition and clinical outcomes were compared between 3 groups of patients: (1) early parenteral nutrition (PN) (<48 hours after admission) and late EN (>48 hours after admission), (2) late PN and late EN, and (3) late EN and no PN. RESULTS Of the 703 patients who met our inclusion criteria, 541 (77.0%) medical patients received late EN and no PN. In patients receiving late EN and PN, 83 (11.8%) received early PN and 79 (11.2%) received late PN. Adequacy of calories and protein from total nutrition was highest in the early PN group (74.1% ± 21.2% and 71.5% ± 24.9%, respectively) and lowest in the late EN group (42.9% ± 21.2% and 38.7% ± 21.6%) (P < .001). The proportion of patients dead or remaining in hospital was significantly higher for early PN compared with late EN and PN (unadjusted hazard ratio for early PN = 0.55; 95% confidence interval, 0.37-0.83, P = .015). However, this difference did not remain significant (P = .65) after adjustment for baseline characteristics. CONCLUSIONS The results suggest that initiating PN early, when it is not possible to feed enterally early, may improve provision of calories and protein but is not associated with better clinical outcomes compared with late EN or PN.
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Affiliation(s)
- Naomi E Cahill
- Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada.
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Abstract
The outcome for children with congenital enteropathies or massive surgical resections has improved significantly over the past two decades. Advances in understanding of the pathophysiology of intractable diarrhea and of the mutations causing many of the congenital enteropathies have enabled initiation of preventive measures for intractable diarrhea, and have enabled clinicians to provide focused treatment of immune-mediated congenital diarrheal illnesses. Children with surgical short bowel syndrome also face an improved outcome because of improvements in the composition of parenteral nutrition (TPN) and in enteral alimentation strategies. It is now recognized that, through adaptation, small intestinal surface area and absorptive function may improve over time to facilitate emancipation from parenteral nutrition. Beyond provision of enteral nutrition, ancillary therapies such as judicious use of acid suppression, antibiotics, prokinetic agents, and soluble fiber seem to accelerate the rate of adaptation in young children. In the future, trophic hormones such as epidermal growth factor (EGF) or glucagon-like peptide 2 (GLP-2) may become routine members of the therapeutic armamentarium for surgical short bowel syndrome, thus further improving outcomes.
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Affiliation(s)
- Samuel A Kocoshis
- University of Cincinnati College of Medicine, Nutrition and Intestinal Transplantation, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
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20
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Affiliation(s)
- John C. Barbato
- From University Hospitals, Mayfield Village Medical Center, Mayfield Village, Ohio
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Paluszkiewicz P, Dudek W, Lowery K, Hart CA. Pancreas sparing duodenectomy as an emergency procedure. World J Emerg Surg 2009; 4:19. [PMID: 19445694 PMCID: PMC2694147 DOI: 10.1186/1749-7922-4-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Accepted: 05/16/2009] [Indexed: 12/28/2022] Open
Abstract
Background The operative techniques to close extensive wounds to the duodenum are well described. However, postoperative morbidity is common and includes suture line leak and the formation of fistulae. The aim of this case series is to present pancreas sparing duodenectomy as a safe and viable alternative procedure in the emergency milieu. Methods Five patients underwent emergency pancreas sparing duodenal excisions. Re-implantation of the papilla of Vater or the papilla with a surrounding mucosal patch was performed in two patients. In one, the procedure was further supplemented with a duodenocholangiostomy, stapled pyloric exclusion and enterogastrostomy to defunction the pylorus. In another three patients, distal duodenal excisions were done. Results In four patients, an uneventful recovery was made. One patient died following a myocardial infarction. The surgery lasted meanly 160 minutes with average blood loss of approximately 500 milliliters. The mean hospital stay was 12 days. Enteral nutrition was introduced within the 20 hours after the surgery. Long term follow-up of all surviving patients confirmed a good outcome and normal nutritional status. Conclusion Based on the presented series of patients, we suggest that pancreas-sparing duodenectomy can be considered in selected patients with laceration of the duodenum deemed unsuitable for surgical reconstruction.
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Affiliation(s)
- Piotr Paluszkiewicz
- Department of Surgery and Surgical Nursing, Medical University of Lublin, Lublin, Poland
| | - Wojciech Dudek
- Department of Surgery, Pilgrim Hospital, Boston, Lincolnshire, UK
| | - Kathryn Lowery
- Department of Surgery, Pilgrim Hospital, Boston, Lincolnshire, UK
| | - Colin A Hart
- Department of Surgery, Pilgrim Hospital, Boston, Lincolnshire, UK
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Peptide YY induces intestinal proliferation in peptide YY knockout mice with total enteral nutrition after massive small bowel resection. J Pediatr Gastroenterol Nutr 2009; 48:517-25. [PMID: 19367178 DOI: 10.1097/mpg.0b013e31818c5fd8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE In previous research, peptide YY (PYY) administered in supraphysiological doses did not induce significant proliferative effects in rats that were allowed to feed ad libitum after massive small bowel resection (SBR). The main reason may well have been the interference of endogenous PYY released from L cells in the distal bowel in response to the presence of augmented unabsorbed intraluminal nutrients. The purpose of the present study was to explore the effect of PYY on intestinal proliferation with total enteral nutrition (TEN) in a SBR model of PYY knockout (Pyy(-/-)) mice, which do not produce endogenous PYY. MATERIALS AND METHODS Pyy(-/-) mice were assigned into 3 experimental groups: sham mice (sham group) underwent bowel transection and reanastomosis, and received TEN; SBR mice (SBR group) underwent a 50% small bowel resection, and received TEN; and SBR-PYY mice (SBR-PYY group) underwent a 50% small bowel resection, received TEN, and were treated with PYY1-36 subcutaneously from day 2 postoperatively. Parameters of enterocyte proliferation and apoptosis were determined on day 8 following operation. RESULTS SBR-PYY mice demonstrated a significant increase in (vs SBR) bowel and mucosal weights, mucosal DNA and protein, villus height, and crypt depth in jejunum and ileum. SBR-PYY mice also showed an increased crypt cell proliferation index in jejunum and ileum and decreased villus cell apoptotic index in ileum compared with SBR animals. CONCLUSIONS In an SBR model of Pyy(-/-) mice, PYY induces proliferation of residual intestine with TEN.
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Yokohama S, Aoshima M, Nakade Y, Shindo J, Maruyama J, Yoneda M. Investigation and prediction of enteral nutrition problems after percutaneous endoscopic gastrostomy. World J Gastroenterol 2009; 15:1367-72. [PMID: 19294767 PMCID: PMC2658839 DOI: 10.3748/wjg.15.1367] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate and predict enteral nutrition problems after percutaneous endoscopic gastrostomy (PEG).
METHODS: We retrospectively analyzed data for 252 out of 285 patients who underwent PEG at our hospital from 1999 to 2008. Enteral nutrition problems after PEG were defined as: (1) patients who required ≥ 1 mo after surgery to switch to complete enteral nutrition, or who required additional parenteral alimentation continuously; or (2) patients who abandoned switching to enteral nutrition using the gastrostoma and employed other nutritional methods. We attempted to identify the predictors of problem cases by using a logistic regression analysis that examined the patients’ backgrounds and the specific causes that led to their problems.
RESULTS: Mean age of the patients was 75 years, and in general, their body weight was low and their overall condition was markedly poor. Blood testing revealed that patients tended to be anemic and malnourished. A total of 44 patients (17.5%) were diagnosed as having enteral nutrition problems after PEG. Major causes of the problems included pneumonia, acute enterocolitis (often Clostridium difficile-related), paralytic ileus and biliary tract infection. A multivariate analysis identified the following independent predictors for problem cases: (1) enteral nutrition before gastrectomy (a risk reduction factor); (2) presence of esophageal hiatal hernia; (3) past history of paralytic ileus; and (4) presence of chronic renal dysfunction.
CONCLUSION: Enteral nutrition problems after PEG occurred at a comparatively high rate. Patient background analysis elucidated four predictive factors for the problem cases.
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Enteral and parenteral nutrition distinctively modulate intestinal permeability and T cell function in vitro. Eur J Nutr 2008; 48:12-21. [PMID: 18998044 DOI: 10.1007/s00394-008-0754-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Accepted: 10/21/2008] [Indexed: 01/08/2023]
Abstract
BACKGROUND Nutritional support is an established element of therapy for various indications. However, its impact on the mucosal barrier function is not well understood. AIM OF THE STUDY We investigated the influence of EN and PN on intestinal epithelial cells and peripheral blood (PBMC) and lamina propria mononuclear cells (LPMC), all of which are involved in the mucosal defense against bacterial translocation and systemic inflammation. METHODS Integrity of epithelial cells was measured as transepithelial electrical resistance (TER) of confluent Caco-2 monolayers in the presence of 1% EN, PN and a parenteral amino acid mixture (AM). To determine wound healing capacities, an established migration model with IEC-6 cells was used. Furthermore, we investigated apoptosis, cell activation, proliferation and cytokine secretion of Caco-2, HT29 and of stimulated PBMC and LPMC cultured with or without 1 and 5% EN, AM or PN. RESULTS We demonstrated that EN, AM and PN promoted the integrity of the epithelial monolayer and reconstituted epithelial cell continuity TGF-beta-dependently and -independently. Interestingly, only PN induced apoptosis and decreased the mitochondrial membrane potential. The activation status of PBMC was significantly reduced by EN and AM. Specifically, EN leads to an increased apoptosis rate, inhibited cell cycle progression and increased pro-inflammatory cytokine secretion. Both EN and PN reduced the activation status and the release of pro- and anti-inflammatory cytokines. CONCLUSIONS Our study provides evidence that by promoting wound healing and regulating T cell function, EN, AM, and PN potently interact with the intestinal barrier and immune system, thus justifying its use in diseases accompanied by impaired mucosal barrier function.
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Abstract
PURPOSE OF REVIEW The utilization of enteral nutrition in critically ill patients is frequently suboptimal. This may be due, in part, to ongoing controversies regarding appropriate use of enteral support, but there are also perceived barriers to its use even when there is good evidence that it can be given. This review was undertaken to outline some of these controversies and barriers to use of enteral nutrition in the ICU. RECENT FINDINGS Although the advantages of enteral nutrition may have been overstated, it remains preferable to parenteral nutrition for support of critically ill patients. Early initiation of enteral support is a reasonable approach. Many patients with perceived contraindications to enteral therapy are actually good candidates for its use. Frequent interruptions in enteral nutrition lead to suboptimal nutrient delivery, but might be overcome by use of specific protocols emphasizing safe and effective utilization of enteral support. SUMMARY Use of enteral nutritional support is recommended for critically ill patients requiring specialized nutritional support. Barriers to its use could be overcome by better educating providers about indications for use and by developing methods to avoid undue interruption of therapy.
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Zhang W, Li N, Zhu W, Shi Y, Zhang J, Li Q, Li J. Peptide YY induces enterocyte proliferation in a rat model with total enteral nutrition after distal bowel resection. Pediatr Surg Int 2008; 24:913-9. [PMID: 18512063 DOI: 10.1007/s00383-008-2176-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2008] [Indexed: 01/01/2023]
Abstract
The main reason why enterocyte proliferative effects of peptide YY (PYY) have not been detected in rats undergoing massive small intestinal resection after feeding may have been the background activity of markedly increased endogenous PYY released from L cells in the distal gut in response to the intraluminal nutrients. The purpose of the present study was to evaluate the effects of PYY on enterocyte proliferation in a rat model of distal bowel resection (DBR) with total enteral nutrition (TEN). Male, adult Sprague-Dawley rats were assigned into three experimental groups: sham rats underwent bowel transection and reanastomosis, DBR rats underwent the resection of 40 cm distal small intestine and colon, and DBR-PYY rats underwent distal bowel resection as above, and were treated with PYY(1-36) from day 2 to day 14 postoperatively. During days 2-14 postoperatively, all animals received isocaloric TEN. At the endpoints, plasma PYY levels and parameters of enterocyte proliferation were determined. Compared with the sham group, DBR rats demonstrated a significant decrease in plasma PYY levels, and a significant increase in intestinal bowel and mucosal weight, mucosal DNA and protein content, villus height and crypt depth, and crypt cell proliferation index. Administration of PYY (DBR-PYY group) led to a significant increase in plasma PYY levels, intestinal bowel and mucosal weight, mucosal DNA and protein content, villus height and crypt depth, and crypt cell proliferation index in comparison with the DBR untreated group. We conclude that administration of PYY increases the plasma PYY levels, and PYY induces enterocyte proliferation with TEN after distal bowel resection.
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Affiliation(s)
- Wei Zhang
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
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Ali NA, O'Brien JM, Dungan K, Phillips G, Marsh CB, Lemeshow S, Connors AF, Preiser JC. Glucose variability and mortality in patients with sepsis. Crit Care Med 2008; 36:2316-21. [PMID: 18596625 PMCID: PMC3176449 DOI: 10.1097/ccm.0b013e3181810378] [Citation(s) in RCA: 300] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Treatment and prevention of hyperglycemia has been advocated for subjects with sepsis. Glucose variability, rather than the glucose level, has also been shown to be an important factor associated with in-hospital mortality, in general, critically ill patients. Our objective was to determine the association between glucose variability and hospital mortality in septic patients and the expression of glucose variability that best reflects this risk. DESIGN Retrospective, single-center cohort study. SETTING Academic, tertiary care hospital. PATIENTS Adult subjects hospitalized for >1 day, with a diagnosis of sepsis were included. INTERVENTIONS None. MEASUREMENTS Glucose variability was calculated for all subjects as the average and standard deviation of glucose, the mean amplitude of glycemic excursions, and the glycemic lability index. Hospital mortality was the primary outcome variable. Logistic regression was used to determine the odds of hospital death in relation to measures of glucose variability after adjustment for important covariates. MAIN RESULTS Of the methods used to measure glucose variability, the glycemic lability index had the best discrimination for mortality (area under the curve = 0.67, p < 0.001). After adjustment for confounders, including the number of organ failures and the occurrence of hypoglycemia, there was a significant interaction between glycemic lability index and average glucose level, and the odds of hospital mortality. Higher glycemic lability index was not independently associated with mortality among subjects with average glucose levels above the median for the cohort. However, subjects with increased glycemic lability index, but lower average glucose values had almost five-fold increased odds of hospital mortality (odds ratio = 4.73, 95% confidence interval = 2.6-8.7) compared with those with lower glycemic lability index. CONCLUSIONS Glucose variability is independently associated with hospital mortality in septic patients. Strategies to reduce glucose variability should be studied to determine whether they improve the outcomes of septic patients.
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Affiliation(s)
- Naeem A Ali
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine and Center for Critical Care, Department of Internal Medicine, The Ohio State University Medical Center, Columbus, Ohio, USA.
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